Rethinking how we detect liver disease
Liver disease is the fifth most common cause of death in the UK, largely because it’s not usually diagnosed until so advanced that it’s difficult to treat.
Identifying it early gives people the chance to make lifestyle changes to reverse the damage which improves their health and, consequently, saves NHS resources.
Thanks to work led by Nottingham’s Professors Neil Guha and Guru Aithal there is now a way to make a diagnosis in GP surgeries and a new pathway for patients that won the ‘Improving the Value of Diagnostic Services’ award at the 2019 Health Services Journal (HSJ) Value Awards.
Patients with risk factors, which include type 2 diabetes and alcohol use, are offered a non-invasive test called a Fibroscan® to diagnose chronic liver disease often when there are no apparent symptoms. Fibroscan® was first used to test the ripeness of cheese in France but now this diagnosis is available at more than 100 GP practices across four Clinical Commissioning Groups serving a population of around 700,000 people.
The mobile scanner reduces the need for a biopsy and the results are instant which means clinicians can agree a treatment plan with the patient straight away.
Professor Guha said: “Because the liver can regenerate catching liver disease at an early stage is critical. By allowing patients with risk factors to be tested in the community we can intervene earlier and potentially avoid future hospital treatment.”
"Because the liver can regenerate catching liver disease at an early stage is critical. By allowing patients with risk factors to be tested in the community we can intervene earlier and potentially avoid future hospital treatment."
The Scarred Liver project has been a collaborative effort supported by the Research and Innovation team at Nottingham University Hospitals NHS Trust and the NIHR Nottingham Biomedical Research Centre. For the pilot studies the team worked closely with the East Midlands Academic Health Science Network, GP practices and clinical commissioners.
During implementation in Nottingham 20,368 people were analysed with 2,022 identified to be at risk. Of those, 230 patients had signs of significant liver disease and 26 new cases of cirrhosis were diagnosed. Without this pathway these patients wouldn’t have known they had the condition until the symptoms were so far advanced their quality of life would be impacted.
In addition to the pathway Professors r Guha and Aithal have collaborated with academics from the Universities of Southampton and Newcastle to develop a non-invasive blood test called ELF that negates the need for liver biopsies in 80% of cases. The collaborative research and validation study provided critical clinical evidence that has seen the test achieve CE marking and NICE approval.
Thanks to his contribution to transforming the way in which liver disease is diagnosed Professor Guha was chosen to be an NHS Innovation Accelerator Fellow in 2015. This scheme supports exceptional individuals scale their high impact, evidence-based innovations to help the NHS adopt pioneering initiatives.
Neil Guha is Professor of Hepatology, Faculty of Medicine and Health Sciences
Professor Guru Aithal is Deputy Director and Theme Lead, NIHR Nottingham BRC, Faculty of Medicine and Health Sciences,